Origin of both right and left main (LM) coronary arteries from the pulmonary trunk (PT) rarely allows survival for more than 2 weeks after birth. Origin of the LM coronary artery from the PT with origin of the right coronary artery from the aorta allows longer survival but usually (80%) for no more than 1 year after birth. Origin of the right coronary artery from the PT and the LM coronary artery from the aorta, in contrast, allows survival into adulthood and indeed maybe even a normal life span. Because the LM coronary artery is equivalent to 2 major coronary arteries, whenever the LM arises from PT, whether in association with the right or when isolated, survival is short. When 1 major branch of the LM, however, arises from the PT and both the right and the other major LM branch arise from aorta survival should be similar to that in patients in whom the right coronary artery arises from the PT and the LM from the aorta. This report describes a man in whom the left anterior descending (LAD) coronary artery arose from the PT and the right and LC coronary arteries, from aorta.